Liver Haemangioma

Question 1

What is the defn of a liver haemangioma?

Answer 1

Hamartomatous (benign, tumour-like growth w/ mixed disorganized cells + tissue) outgrowths of endothelium made of widened blood vessels rather than true neoplasms. Some express oestrogen factors

Question 2

Discuss the epidemiology of liver haemangiomas

Answer 2

prevalence 3%-20%
>F (5-6:1), middle-aged women
most common benign liver tumour

Question 3

How does a pt w/ a liver haemangioma present?

Answer 3

usually asymptomatic, found incidentally
pain from liver capsule stretch - non-sp upper abd fullness/vague abd pain
mass effects compressing on surr organs
life-threatening haemorrhage
hrt failure from large arteriovenous shunt
Kasabach-Merritt syndrome for large haemangioma

Question 4

How do you dx a liver haemangioma?

Answer 4

Don’t biopsy!
Imaging investigations:
U/S (70-80% accuracy) - well-defnd, lobulated, homogenous, hypoechoic masses; compressibility of lesion = pathgnomonic
CT - tumour appears brightest & uniformly enhanced in delayed phases
Gadolinium enhanced MRI

Question 5

What is the tx for a liver haemangioma?

Answer 5

majority tx by observation
sx/complicated: surgical removal - enucleation under vascular control or formal anatomical resection
large, unresectable lesions -> low dose radiation therapy or embolization